HIV This Week

Schulte J, Dominguez K, Sukalac T, Bohannon B, Fowler MG; Pediatric Spectrum of HIV Disease Consortium. Declines in low birth weight and preterm birth among infants who were born to HIV-infected women during an era of increased use of maternal antiretroviral drugs: Pediatric Spectrum of HIV Disease, 1989-2004. Pediatrics 2007;119:e900-6.

Schulte and colleagues’ goal was to determine trends in low birth weight and preterm birth among US infants born to HIV-infected women. The authors used data from the longitudinal Pediatric Spectrum of HIV Disease, a large HIV cohort, to assess trends in low birth weight and preterm birth from 1989 to 2004 among 11,321 study infants. Among women with prenatal care, the authors also assessed risk factors, including maternal antiretroviral therapy during pregnancy, that were predictive of low birth weight and preterm birth using univariate and multivariate logistic regression models. Overall, 11,231 of 14,464 infants who were enrolled in Pediatric Spectrum of HIV Disease were tested during the neonatal period. From 1989 to 2004, testing increased from 32% to 97%. The proportion of HIV-exposed infants who had low birth weight decreased from 35% to 21% and occurred in all racial/ethnic groups. Prevalence of preterm birth decreased from 35% to 22% and occurred in all groups. Any maternal antiretroviral therapy use increased from 2% to 84%. Among 8793 women who had prenatal care, low birth weight was associated with a history of illicit maternal drug use, unknown maternal HIV status before delivery, symptomatic maternal HIV disease, black race, Hispanic ethnicity, and infant HIV infection. Antiretroviral therapy or lack of it was not associated with low birth weight. Among women with prenatal care, preterm birth was associated with a history of illicit maternal drug use, symptomatic maternal HIV disease, no antiretroviral therapy, receipt of a 3-drug highly active antiretroviral therapy regimen with protease inhibitors, black race, and infant HIV infection. The authors conclude that the proportion of infants who had low birth weight or were born preterm declined during an era of increased maternal antiretroviral therapies. These Pediatric Spectrum of HIV Disease trends differ from the overall increases in both outcomes among the US population.

Editors’ note: It is quite striking that preterm births and low birth weight are on the rise in the USA overall and yet pregnancy outcomes for women living with HIV in all racial/ethnic groups improved from 1999 to 2004. Since antiretroviral therapy or lack of it was not associated with low birth weight, perhaps it was antenatal care itself that turned the tide for infants born to HIV-infected mothers in the US.

Hutchinson GA, Jameson EM. Prevalence and risk factors for HIV infection in pregnant women in north Trinidad. West Indian Med J 2006;55:346-50.

The prevalence of HIV infection in the Caribbean is reported to be second only to sub Saharan Africa. HIV in pregnancy has become an increasingly important focus of attention in HIV research because of its role in contributing to spread of the infection. This study sought to establish the prevalence and risk factors associated with HIV infection among antenatal women in the northwest region of Trinidad. Using a cross-sectional survey design, interviews were conducted with each new pregnant attendee to the antenatal clinics in the county of St George West over a six-month period after informed consent was obtained. These women were all offered routine HIV testing in their antenatal assessment. Their HIV results were confirmed through the island’s HIV monitoring facility. The interviews included questions on demographics, known risk factors for HIV infection, mental health history and related information on their partners. Women who had refused testing were also asked to give reasons for this. There were a total of 541 women attending the clinic for the first time during the six-month period seven of them refused testing. Of the remaining 534 women, 37 were HIV positive (6.8%). Fourteen of the HIV positive women (37.8%) admitted to knowing of their status prior to becoming pregnant. Risk factors significantly associated with positive HIV status were early age of first sexual intercourse, a history of sexually transmitted disease, mental health problems and homelessness. Regression analysis established a history of sexually transmitted disease as the only independent predictor of HIV infection in this sample. These findings reveal a high rate of HIV infection among pregnant women in northwest Trinidad and suggest that having a history of sexually transmitted disease is a key determinant of this. Prevention efforts must therefore be targeted at identifying the factors which influence this and these include early sexual activity and the experience of childhood sexual abuse.  

Editors’ note: Although a history of sexually transmitted disease was the only independent predictor of HIV infection among pregnant women in north-west Trinidad, sexually transmitted infections are themselves associated with broader problems which must be addressed on the grounds of human rights (child sexual abuse) and psychosocial health (homelessness and mental health problems). Delaying onset of sexual debut would go a long way to reducing risk for Trinidadian adolescents and young women.